title: Minimally invasive aortic valve replacement with self-anchoring Perceval valve.
abstract: OBJECTIVE
  Although minimally invasive aortic valve replacement (AVR) has been proposed to cause less morbidity in patients, it still has not seen broad application. The study aim was to evaluate the implantation of the self-anchoring aortic valve (Perceval S; Sorin) via a mini-sternotomy.
  
  
  METHODS
  As a part of a multicenter, European, prospective, non-randomized, clinical trial, 35 patients (30 females, five males; mean age 80 +/- 4 years) with isolated aortic valve stenosis (mean gradient 48 +/- 21 mm Hg) were operated on at the authors' center. Perceval S self-anchoring valves were implanted following a mini-sternotomy, extracorporeal circulation (ECC), aortic cross-clamping, cardioplegic arrest and removal of the calcified native valve. The mean EuroSCORE and STS score were 12 +/- 9% and 4 +/- 2%, respectively.
  
  
  RESULTS
  There were no failures of deployment, and nor was there any intra-procedure or 30-day mortality. The mean ECC-time was 70 +/- 24 min, and cross-clamp time 34 +/- 10 min. The valve implantation time was 9 +/- 5 min. Perioperative echocardiography revealed no significant aortic insufficiency or paravalvular leakage. The postoperative mean gradient was 16 +/- 6 mmHg. At follow up, there was no paravalvular leakage or significant valvular insufficiency. No migration or dislodgement of the prosthesis occurred.
  
  
  CONCLUSIONS
  This trial highlights the advantages of the Perceval S self-anchoring valve which, technically is a more reproducible alternative for minimally invasive AVR. As the valve does not need to be sutured, the limited exposure is not a disadvantage even in patients with calcified or small aortic roots. This also potentially reduces the cross-clamp and ECC-times. This valve may enable a broader application of minimally invasive AVR.
authors.affiliation: Division of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. Shrestha.Malakh.Lal@mh-hannover.de
authors.forename: Malakh
authors.initials: M
authors.lastname: Shrestha
authors.forename: Rebecca
authors.initials: R
authors.lastname: Timm
authors.forename: Klaus
authors.initials: K
authors.lastname: Höffler
authors.forename: Nurbol
authors.initials: N
authors.lastname: Koigeldiyev
authors.forename: Nawid
authors.initials: N
authors.lastname: Khaladj
authors.forename: Christian
authors.initials: C
authors.lastname: Hagl
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.forename: Samir
authors.initials: S
authors.lastname: Sarikouch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001705:Bioprosthesis; D005112:Extracorporeal Circulation / Q000706:statistics & numerical data; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D013249:Sternum / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome